Agenda item

(Item 4 – Report by Overview and Scrutiny Manager)

            (1)       The Chairman introduced the paper on restructuring and refocusing the Committee. He highlighted the need to update the protocol for the operation of the Committee, which dated from 2001. Discussions were to be held with District Council colleagues in relation to the potential to formally delegate to them some of the statutory powers of the NHS Overview and Scrutiny Committee.  The Chairman emphasised that the Health scrutiny function must operate independently of the County Council’s Executive; the Committee’s independence was a vital element in discharging its role.  In relation to the Work Programme, there had been discussions across the political parties and with health colleagues from East and West Kent to obtain their views.  Tabled at the meeting was a list of potential items which had come out of these discussions.  The Chairman stated that he had been impressed with the way that Parliamentary Select Committees worked and he would like the Committee to work in a similar style.  This would involve setting an agenda at least two to three months in advance and there being a greater understanding of the issues by Members prior to the meeting. This would give Members more opportunity to ask questions, rather than listening to presentations.  He referred to the comments of Ms Ross, the Director of Civic Engagement for West Kent PCT, in relation to the way that the Committee worked, which had been circulated to Members. He emphasised that, while NHS colleagues would have an input into the Work Programme, it would also reflect the fact that part of the role of Members of the Committee was to represent patients’ and residents’ views, and to consider broader issues, including that of value for money.

            (2)       Members were then given the opportunity to discuss and comment on the issues raised in the document. In relation to the issue of access to health services, particularly as regards transport links, Members, as well as health service colleagues, had a role to play in helping to educate the public about the changing role of the Ambulance Service. This was particularly so in respect of the skill-set that ambulance staff now had and the impact of this on A&E services.  It was noted that the South East Coast Ambulance Trust covered three counties and that, given this, the Kent Locality Group of the South East Coast Ambulance PPIF had a particularly important role to play.

Division of work between County Council and District Council Scrutiny Committees

            (3)       The Chairman reported that a meeting was being arranged with District Council colleagues to discuss the way in which a joint work programme, with delegation of certain items to District Scrutiny Committees, could operate.  He stated that there was no fixed timescale for this but it would need to be dealt with as soon as possible.

            (4)       During discussion of this item the following points were made:-

•           Over the last few years there had been much duplication of enquiries at District and County levels, and officers of various health service organisations had been called to a variety of meetings to give the same presentation.  This was not productive or useful for either health service or local government colleagues.

•           Health scrutiny discussions at District Council level were valuable in trying to gauge the opinions of local people for whom the NHS was trying to provide services.  It was essential that elected representatives looking after the local community led on these issues; but they first needed to understand what the issues were and know what the potential service-delivery solutions were.

•           The role of County Councillors was more strategic and they should be talking to PCTs as well as acute Trusts.  There should be a separation of what the NHS Overview and Scrutiny Committee did at county level and what was done to scrutinise the health service at District Council level.

•           The OSC should be able to request District Councils to look at issues in their locality and to come back with suggestions on the way forward.

•           When engaging with District Council colleagues it was necessary to be aware that they operated in different ways – for example, their Members often worked during the day and, therefore, preferred to attend evening meetings.  It would be necessary to think of innovative ways of engaging with District Council colleagues.

•           It was important to meet with the District Councils and see what they would be willing and able to take on; and to have proper devolvement and engagement.

•           If issues were devolved to District Councils it was important to have a feedback mechanism to NHS OSC, so that Members could be made aware of the outcomes of discussions.

•           District Councils tended to want to be involved in local issues and were generally happy to leave the strategic issues to the County Council.

•           Parishes also needed to be involved in this process, to avoid duplication of effort on the part of health service colleagues.

•           Mr Phoenix made the point that on certain issues which were focused across a number of districts it might not be appropriate for this to be dealt with by just one of the districts.  For example, regarding the proposed reconfiguration of emergency services at Maidstone Hospital, he did not believe that this was an issue that could appropriately be dealt with by Maidstone Borough Council, as it impacted on other districts. 

•           Working out which issues could be dealt with effectively by District Councils and which needed to be retained by NHS OSC involved achieving a delicate balance.

•           It was important that the County Council had a co-ordinating role in relation to NHS Overview and Scrutiny.  NHS OSC should be kept aware of what was going on at District level by reports back to the Committee. 

•           Consideration should also be given to having representatives from the County Council on some District Council Scrutiny Committees, as appropriate.

•           It was important to have a draft protocol to form the basis of the discussion at the first meeting with District Councils.  This should give a definition of which issues would be strategic and, therefore, retained by NHS OSC; and which could be classed as local and, therefore, possibly devolved to the Districts.

Meetings of the NHS Overview and Scrutiny Committee

            (5)       In discussion the following points were made about the work of the Committee:

•           It would be helpful to look more than two or three months ahead when planning agendas.

•           Half-day meetings of the NHS Overview and Scrutiny Committee were good, as long as it was possible to have a focused agenda.

•           It was also useful from the point of view of public engagement and accessibility to hold meetings in appropriate locations depending on items on the agenda.  This helped with engaging stakeholders.

•           It would also be helpful for the Committee to consider holding site visits to complement its meeting agendas.

Other Issues

            (6)       In response to a question from a Member, Mr Phoenix stated that it was open to the NHS Overview and Scrutiny Committee to look at any NHS issue.  However, it was only where there was a “substantial variation” to services that NHS bodies had formally to consult the Committee. He confirmed that this was something that they welcomed doing as part as of their wider duty to consult with stakeholders.  In relation to contentious issues, which could, for example, just mean that one or two people did not like the renaming of a service, it was necessary for the Committee to take a view on whether this was the type of issue that it would wish to consider.

            (7)       Mrs Angell asked for information on where LINks fitted in with the work of the Committee and how Kent would be managing the LINks programme.  In response to this, it was agreed that a brief update on LINks would be given at the next meeting.

            (8)       Mr Gibbens informed Members that a steering group on LINks was being set up, which he would be chairing.  The Chairman of the Committee, the Vice Chairman and the Liberal Democrat spokesman would also be Members of this group; and there would be representatives from the voluntary sector and PCTs.  As part of this process, they would be holding focus groups across Kent in late October/early November working towards the establishment of LINks by 1 April 2008.  He anticipated that a formal decision would be taken on the establishment of LINks in January or February next year.  The Chairman emphasised the importance of the Committee having involvement in the development of LINks on a cross-party basis.

            (9)       Ms Ross informed the Committee that she welcomed the general direction of travel outlined in the paper and was pleased to hear that the Committee would like to have a role in raising public awareness in relation to NHS changes.  Ms Selman stated that discussions were underway with officers about having a robust induction for Members before the Committee’s work was refocused.  Ms Ross stated that a key challenge was to balance the list of items which the NHS had a duty to consult the NHS Overview and Scrutiny Committee about and other issues which the Committee might wish to raise with them.

            (10)     The Chairman stated that an important factor in enabling the Committee to carry out its statutory role on behalf of Kent residents was to have an understanding of the financial situations of local NHS bodies and to have confidence that money was being used in the best interests of Kent residents.  Discussions could be held with health service colleagues to work out how best to do this.

            (11)     Mr Daley referred to what it could be argued were inconsistencies within West Kent PCT’s “Fit for the Future” Summer 2007 Update document. It said that financial issues were not driving changes; but it also said that if the changes were not made, money issues would force them to be made. He referred to the removal of the Pain Clinic from Maidstone, which he believed had occurred for financial reasons. Mr Phoenix said that the document might sound contradictory but it was not. He explained the situation in relation to the efficiency savings which NHS bodies were required to make year-on-year. In some areas, the NHS faced financial pressures in addition to the requirement to make efficiency savings; this was not the case in Kent. He stated that the nature and pace of change in the health service was faster than he could ever remember it; and the key driver was the need to improve standards. He gave the example of the stroke standards.  He stated that it was a challenge to find a way within the existing financial context to make progress in relation to quality standards. It was important to make sure that scrutiny was not a barrier for change.  Some changes were difficult for institutions, practitioners and patient groups to feel comfortable with.  There was a need for all those involved to collectively keep their eye on the aim which was to ensure the best health service for patients.

            (12)     The Chairman pointed out that the Committee was made up of elected Members who would wish to speak up robustly on behalf of patients and residents where they felt it was necessary – but the aim was to be constructive.

(13)     RESOLVED:-

a)         That the suggestions set out in paragraph 9 of the report be endorsed and that it be acknowledged a large amount of work needed to be done to achieve these.

b)         That the Committee welcome the work being carried out to revise the protocols, including discussions with NHS and District Council colleagues, regarding the delegation of some issues to District Councils and the establishment as part of this of a clear reporting-back process to the Committee.

c)         That a brief update on LINks be given to the next meeting of the Committee in October.

d)         That the proposal for an induction/briefing day for Members be welcomed.